Provider Demographics
NPI:1093850802
Name:GIBBS, PAULA (MT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2327
Mailing Address - Country:US
Mailing Address - Phone:352-694-4427
Mailing Address - Fax:
Practice Address - Street 1:85 WABASH AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2327
Practice Address - Country:US
Practice Address - Phone:352-694-4427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist